IMCI Health Facility Survey - World Health Organization IMCI Health Facility Survey World Health...

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Transcript of IMCI Health Facility Survey - World Health Organization IMCI Health Facility Survey World Health...

  • Sudan March - April 2003

    IMCI Health Facility Survey

    World Health Organization Regional Office for the Eastern Mediterranean

    Federal Ministry of Health Republic of Sudan

  • OBJECTIVES

    1

  • ! To assess the quality of outpatient care, including both clinical and counselling care, provided to sick children aged 2 months up to 5 years old at health facilities implementing the IMCI strategy;

    To describe organizational and other “health systems support” elements influencing the quality of care and identify major constraints to it;

    ! To measure key indicators of quality care to monitor progress of the IMCI strategy at health facilities; and

    ! To recommend further approaches to improving the quality of outpatient child health services.

    !

    2

  • METHODOLOGY

    3

  • SELECTION OF HEALTH FACILITIES

    Systematic, random selection of 66 health facilities from a list of 136 facilities in 8 States in urban and rural areas and by type of facility:

    ! implementing IMCI; and

    ! with estimated daily caseload of at least 2 cases below 5 years old

    4

  • DISTRIBUTION OF HEALTH FACILITIES IN THE SAMPLE BY LOCATION AND TYPE

    2

    32

    6

    3

    11 12

    Hospitals

    N o

    . o

    f fa

    ci lit

    ie s

    Health centres Dispensaries

    0

    5

    10

    15

    20

    25

    30

    35 Urban

    Rural

    5

  • SURVEY FINDINGS

    6

  • 1. Sample characteristics

    2. Quality of clinical care

    3. Factors influencing care

    7

  • 1. SAMPLE CHARACTERISTICS

    ! Case management observations: 364 children aged 2 months up to 5 years old

    ! Gender of cases: 46.7% female

    ! Age: 54.3% under 2 years old

    ! Caretakers interviewed: 350

    ! Mother caretakers: 82.6%

    8

  • CASES MANAGED BY TYPE OF HEALTH PROVIDER (N = 364)

    Nurses 3%

    Medical Assistants 77%

    Doctors 20%

    9

  • 2. QUALITY OF CLINICAL CARE

    ! ASSESSMENT

    ! Classification

    ! Treatment and advice

    ! ASSESSMENT

    10

  • DISTRIBUTION OF MAIN CONDITIONS IDENTIFIED IN THE SAMPLE (N = 364)

    Acute respiratory infections

    Fever

    Diarrhoeal diseases

    Anaemia

    Eye infections

    Ear problem

    Severe malnutrition and Very low weight

    Needing urgent referral

    Percentage of all cases 0 20 40 60 80 100

    63

    57

    30

    17

    11

    9

    7

    4

    11

  • INTEGRATED ASSESSMENT (1) : MAIN TASKS AND INDEX

    5.9 out of 10 tasks

    Child weight taken and checked against growth chart

    Child checked for 3 main symptoms (cough, diarrhoea and fever)

    Child checked for 3 general danger signs

    Child road-to-health card asked for

    Child checked for palmar pallor

    WHO Index of integrated assessment

    75%

    60%

    53%

    45%

    21%

    9%

    Child vaccination status checked

    12

  • INTEGRATED ASSESSMENT (1): MAIN TASKS AND INDEX TRAINED vs UNTRAINED

    Child vaccination status checked

    Child weight taken and checked against growth chart

    Child checked for 3 main symptoms (cough, diarrhoea and fever)

    Child checked for 3 general danger signs

    Child road-to-health card asked for

    Child checked for palmar pallor

    WHO Index of integrated assessment

    79%

    71%

    63%

    58%

    28%

    10%

    6.6

    62%

    23%

    19%

    0%

    0%

    5%

    3.4

    Trained

    Untrained

    out of 10 tasks

    13

  • PERFORMANCE OF SELECTED TASKS: TAKING TEMPERATURE AND WEIGHT

    48

    14

    82

    53

    Temperature taken

    Temperature taken correctly

    Weight taken

    Weight taken correctly

    P e rc

    e n

    ta g

    e o

    f ca

    se s

    in w

    h ic

    h t

    a sk

    d o

    n e

    0

    10

    20

    30

    40

    50

    60

    70

    80

    90

    100

    Temperature Weight 14

  • PERFORMANCE OF SELECTED TASKS: TAKING TEMPERATURE AND WEIGHT TRAINED vs UNTRAINED

    4 0

    55

    46

    0

    10

    20

    30

    40

    50

    60

    70

    80

    90

    100

    P e rc

    e n

    ta g

    e o

    f ca

    se s

    in w

    h o

    m t

    a sk

    d o

    n e

    61

    18

    91

    55

    Temperature taken

    Temperature taken correctly

    Weight taken

    Weight taken correctly

    Trained

    Untrained

    Temperature Weight 15

  • PERFORMANCE OF SELECTED ASSESSMENT TASKS: ARI (N = 228) AND DIARRHOEA (N = 109)

    76

    57

    76

    57

    51

    69

    33

    0

    10

    20

    30

    40

    50

    60

    70

    80

    90

    100 Acute respiratory infections (ARI)

    Diarrhoea

    Respiratory rate

    counted

    Respiratory rate

    counted correctly

    Duration of diarrhoea episode

    asked about

    Presence of blood in stool asked

    about

    Something to drink offered

    Abdomen skin

    pinched

    Abdomen skin

    pinched correctly

    P e rc

    e n

    ta g

    e o

    f ca

    se s

    in w

    h o

    m t

    a sk

    d o

    n e

    ARI Diarrhoea 16

  • SELECTED ASSESSMENT TASKS: ARI AND DIARRHOEA TRAINED vs UNTRAINED

    0

    10

    20

    30

    40

    50

    60

    70

    80

    90

    100

    Respiratory rate

    counted

    Respiratory rate

    counted correctly

    Duration of diarrhoea episode

    asked about

    Presence of blood in stool asked

    about

    Something to drink offered

    Abdomen skin

    pinched

    Abdomen skin

    pinched correctly

    89

    77

    88

    69 64

    82

    41

    15

    33 33

    13

    4

    21

    4

    P e rc

    e n

    ta g

    e o

    f ca

    se s

    in w

    h o

    m t

    a sk

    d o

    n e

    Trained

    Untrained

    ARI Diarrhoea 17

  • ASSESSMENT OF FEEDING PRACTICES: CHILDREN LESS THAN 2 YEARS OLD (N = 189) AND OLDER CHILDREN

    WITH VERY LOW WEIGHT AND/OR ANAEMIA (N = 36)

    Assessed for feeding practices

    Not assessed

    76%

    24% 18

  • ASSESSMENT OF FEEDING PRACTICES IN THE TARGET GROUP TRAINED UNTRAINEDvs

    Child 2 years old or older with very low weight and/or anaemia assessed

    35

    7

    30

    0 0 0

    Child under 2 years old assessed

    Both groups assessed for

    feeding practices

    0

    10

    20

    30

    40

    50

    60

    70

    80

    90

    100 Trained

    Untrained

    P e rc

    e n

    ta g

    e o

    f ca

    se s

    in w

    h o

    m t

    a sk

    d o

    n e

    19

  • 2. QUALITY OF CLINICAL CARE

    ! Assessment

    ! CLASSIFICATION

    ! Treatment and advice

    ! CLASSIFICATION

    20

  • AGREEMENT OF PROVIDER'S CLASSIFICATIONS WITH SURVEYOR'S CLASSIFICATIONS ON MAIN CONDITIONS

    72

    56

    50

    38

    37

    36

    33

    25

    21

    46

    Very severe febrile disease or malaria N=65

    Very severe disease/severe pneumonia or pneumonia

    Dysentery N=8

    Severe malnutrition or very low weight N=26

    Mastoiditis or acute or chronic ear infection N=27

    Diarrhoea with severe or some dehydration N=11

    Severe or non-severe persistent diarrhoea N=10

    Complicated or uncomplicated measles N=4

    Severe anaemia or anaemia N=61

    TOTAL AGREEMENT ON ALL CLASSIFICATIONS ABOVE

    Percentage of matching classifications

    0 20 40 60 80 100

    21

  • AGREEMENT ON CLASSIFICATIONS TRAINED UNTRAINEDvs

    Very severe febrile disease or malaria

    Very severe disease/severe pneumonia or pneumonia

    Dysentery

    Severe malnutrition or very low weight

    Mastoiditis or acute or chronic ear infection

    Diarrhoea with severe or some dehydration

    Severe or non-severe persistent diarrhoea

    Complicated or uncomplicated measles

    Severe anaemia or anaemia

    AGREEMENT ON OVERALL CHILD CLASSIFICATIONS

    Percentage of matching classifications

    71

    59

    50

    43

    30

    50

    43

    0

    23

    0

    49

    77

    40

    20

    75

    0

    0

    14

    0

    49

    Danger signs

    Trained

    Untrained

    No cases seen

    No cases seen

    0 20 40 60 80 100

    22

  • 2. QUALITY OF CLINICAL CARE

    ! Assessment

    ! Classification

    ! TREATM